The Savvy Senior: See how Medicare covers your eyes

Published 9:59 am, Friday, April 25, 2014

What does Medicare cover when it comes to eye care? I currently have good vision insurance through my employer but will lose it when I retire.

Looking Ahead

Dear Looking,

Many retirees are confused with what Medicare does and doesn’t cover when it comes to eye care. The good news is that Medicare covers most medical issues like cataract surgery, treatment of eye diseases and medical emergencies. But unfortunately, routine care like eye exams and eyeglasses are usually the beneficiary’s responsibility.

Here’s a breakdown of how original Medicare covers your eyes, along with some tips that can help you reduce your out-of-pocket costs.

Exams: Routine eye exams (sometimes called “eye refractions”) that test for eyeglasses or contact lenses are usually not covered under Medicare, but you are entitled to a yearly medical eye exam if you have diabetes or are at high risk for glaucoma. People at high risk include diabetics, those with a family history of glaucoma, and older Hispanics and African-Americans.

Medicare will also pay for exams to test and treat medical eye diseases and other problems like macular degeneration, dry eye syndrome, eye infections or if you get something in your eye.

Eyeglasses and contact lenses: Medicare does not pay for eyeglasses or contact lenses, with one exception: If you have had a conventional intraocular lens inserted during cataract surgery, Medicare will pay for eyeglasses or contact lenses following the operation. Otherwise, you are on your own.

To find affordable eye exams or eyeglasses, many retailers provide discounts — between 10 and 30 percent — if you belong to a membership group like AARP or AAA.

Also consider Costco Optical, which is considered by Consumer Reports as the best discount store for good eyewear and low prices - it requires a $55 membership fee. Walmart Vision Centers and For Eyes Optical offer low prices too with no required membership.

You can also save big by buying your glasses online. Some online store sites like zennioptical.com, goggles 4u.com and eyebuydirect.com sell prescription eyeglasses for as little as $7. To purchase glasses online you’ll need your prescription and pupillary distance from an exam, and your frame size.

Eye surgeries: Medicare covers most eye surgeries including cataract surgery to remove cataracts and insert standard intraocular lenses to replace your own. Medicare will not, however, pick up the extra cost if you choose a specialized lens that restores full range of vision, thereby reducing your need for glasses after cataract surgery. The extra cost for a specialized lens can run up to $2,500 per eye.

Eye surgeries that are not covered by Medicare include refractive surgery and cosmetic eye surgery (such as eyelid surgery) that are not considered medically necessary.

Supplemental Insurance

Keep in mind that of the medical eye care services that are covered by Medicare, you’re still responsible for 20 percent of the cost - Medicare pays the other 80 percent.

To help with this out-of-pocket expense, you may want to consider getting a Medigap supplemental policy.

If you can’t afford Medigap insurance, check into EyeCare America at eyecareamerica.org. This is a national program that provides medical eye examinations to seniors, age 65 and older, and up to one year of treatment at no cost.

Advantage Option

Another way you can get extra vision coverage when you join Medicare is to choose a Medicare Advantage plan instead of original Medicare.

Many of these plans - which are sold through private insurance companies (see medicare.gov/find-a-plan) - cover routine eye care and eyeglasses along with dental, hearing and prescription drugs, in addition to all of your hospital and medical insurance.